Presumed Ocular Tuberculosis: A Retrospective Case Series

Abstract

Purpose Despite the common misconception that tuberculosis is an uncommon disease in developed countries such as the United States, cases have become increasingly more prevalent. We aim to further the ophthalmologic understanding of this disease through the presentation of clinical findings in nine cases of presumed ocular tuberculosis seen at our institution. Methods Retrospective case review of all patients diagnosed with tuberculosis with encounters at Saint Louis University Hospital and SLUCare between 1/1/2011 and 3/1/2021. Results Nine patients, 6 females and 3 males ages 18-60 years, were included in this study. All cases (100%) presented with a variety of ocular involvement including anterior uveitis, panuveitis, optic nerve edema, sequential papillitis, granulomatous uveitis, peripheral vasculitis, and possible choroidal granuloma. Known history of tuberculosis exposure was only obtained in 22% of patients. Conclusion The low proportion of patients with known history of tuberculosis exposure and manifestations of ocular tuberculosis highlights the general lack of presumption of diagnosis amongst our population. Patients without known exposure and without extraocular manifestations are most at risk for being misdiagnosed and left untreated for tuberculosis. It is important to address this issue with studies leading to more precise diagnostic guidelines and protocols so that patients will be treated in a timely manner to prevent irreversible visual damage secondary to intraocular inflammation as well as potential systemic manifestations of tuberculosis.